Using minimally invasive techniques, NewYork-Presbyterian Hospital surgeons have pioneered surgery for tumors at the base of the skull, an area that has in the past been considered inoperable. Neurosurgeons, ear, nose, and throat surgeons, plastic surgeons, vascular surgeons, interventional neuroradiologists, and pediatric surgeons collaborate to optimize care for each patient. NewYork-Presbyterian neurosurgeons are world leaders in the use of minimally invasive skull base surgery performed using endoscopes passed through the nostrils. This approach, which allows surgeons to treat patients without facial or scalp incisions, has been used to remove pituitary tumors, chordomas, and other skull base tumors. NewYork-Presbyterian neurosurgeons host workshops and symposia on skull base surgery to train surgeons from other institutions around the world.
At NewYork-Presbyterian Hospital, neurosurgeons employ the "stealth system" in operating rooms. This involves taking MRI or CT scans on the morning of a surgery and projecting a 3-D image onto a screen in the operating room. The image, which can be manipulated, provides surgeons with a map for "neuronavigation" as they perform surgery on a tumor. The technique allows a safer and more complete removal of tumor tissue. In addition, real-time MRI performed in the operating room during surgery enables surgeons to assess the extent of tissue removal as a procedure is being performed.
NewYork-Presbyterian's clinical neurophysiology division maintains one of the most advanced intraoperative neurophysiological monitoring systems in the world. Continuously monitoring the electrical activity of the brain and spinal cord during surgery diminishes the risk of neurological injury by helping the surgeon clearly identify – and avoid – portions of the brain and spinal cord that control key functions, such as movement and sensation. In addition, monitoring in real time allows physicians to detect injury to the brain and spinal cord.
Endoscopic neurosurgery ("neuroendoscopy") involves the insertion of an endoscope, or tiny video camera, through a small incision below the hairline to treat a range of neurological conditions. NewYork-Presbyterian Hospital is a world leader in minimally invasive endoscopic surgery. Patients treated with this minimally invasive technique can expect fewer complications, smaller incisions, faster recovery, and less pain and scarring. Neuroendoscopy has dramatically altered the management of several diseases, including intraventricular brain tumors.
When surgery on or near the spinal cord is required, NewYork-Presbyterian neurosurgeons make the procedure as safe and effective as possible. They employ "neurophysiological" monitoring of spinal function during surgery while using microscopic equipment to ensure precision. Our surgeons may use spinal stabilization techniques to manage metastatic spinal tumors to preserve nerve function and improve patients' quality of life.
Radiosurgical treatment can penetrate areas of the brain that cannot be reached with conventional surgery or other techniques. NewYork-Presbyterian offers radiosurgery with the Gamma Knife® Perfexion™ system and with linear accelerators such as the Brainlab iX system. These techniques allow for a high level of positioning of tiny radiation beams or arcs, minimizing damage to surrounding healthy tissue and increasing the effectiveness of treatment.
IMRT is available for patients with large, irregularly shaped tumors surrounded by healthy radiation-sensitive tissue. This form of therapy directs radiation beams of different intensities at a tumor from different angles and reduces the damage to healthy tissue near the tumor.
Our neurosurgeons and radiation oncologists are also experts in the use of implanted radiation devices to treat brain tumors. They were the first in New York to implant a liquid radiation device (GliaSite®) and the first in the world to use cesium-131 brachytherapy (an implanted radiation source) to treat malignant brain tumors.
Several drugs are available to treat patients with brain and spinal tumors. However, overcoming the obstacle known as the blood-brain barrier (which prevents certain drugs from crossing into the brain to attack tumor cells) has been a formidable challenge for neuro-oncologists. NewYork-Presbyterian physicians are participating in clinical trials of new therapies and developing innovative techniques to deliver therapies more effectively to control brain cancers and extend survival. (See Research section for more information.)